Anesthesia for angioembolization of brain arteriovenous malformations: a retrospective assessment.

We reviewed the anesthetic management of 55 patients under 18 years of age during angioembolization of arteriovenous malformations. Patients were grouped according to age: less than 1 month (A), 1-11 months (B), 1-5 years (C) and 7-13 years (D). All had general endotracheal anesthesia. In groups A and B, approximately 43% received pure narcotic and 43% balanced while only 14% had pure inhalational anesthesia. In groups C and D, 41 and 52% received pure inhalation and balanced anesthesia, respectively, while only 7% had pure narcotics. Hypotension was induced in 50% (C and D) and in 20% (A and B) of the patients. Intraoperative lasix or phlebotomy was used in 28, 16, 13 and 0% of groups A, B, C and D, respectively. Two arrests occurred immediately after the injection of the embolizing material. From our review, no single type of anesthesia can be advocated over all others. The use of invasive monitoring (arterial and central venous lines), precise fluid management and the avoidance of nitrous oxide will help to decrease the incidence of intraoperative complications during anesthesia.